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Is this impotence treatment safe?

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Q:I am at the moment using a drug called prostaglandin E1 to help with erectile dysfunction in the form of an injection, which I administer directly into the shaft of the penis before intercourse

Q:I am at the moment using a drug called prostaglandin E1 to help with erectile dysfunction in the form of an injection, which I administer directly into the shaft of the penis before intercourse.

I've been prescribed 48 injections in all, to be used no more than twice a week.

The specialist said the only side effect in a small number of patients was psychological in the sense that they are reluctant to try intercourse without it.

The only reasons the specialist could think of for why I was having difficulty maintaining an erection was due to long periods of celibacy, stress or problems with irritable bowel syndrome, which I now have under control through diet.

How safe do you consider this drug? Are there any long term consequences from repeated injections with this drug into the penis. I am 35. Name supplied, Swiss Valley, Llanelli......

A:The product you take, made by Nova Pharmaceuticals, is unlicensed. Nevertheless, Parsons Green Ltd holds a wholesale dealer's license on it, which means they can supply it directly to clinics; they own 16 impotence clinics in Britain. John Parsons, one of the directors, explained that there is a licensed prostaglandin product called Cavaject, made by Upjohn. The main difference is that Prostaglandin E1 comes in prefilled syringes, whereas Caverject must be mixed first. Nevertheless, in every other regard, the two products are "bio equivalent", which means the side effects of Caverject are identical to those of your drug.

The theory behind using prostaglandin is that the cause of impotence is organic, rather than psychological, as doctors have always thought. In one study of 56 patients, the impotence of 86 per cent of them had an organic cause (J Urol, October 1987). The increasing prevalence of this problem 38 per cent of men over 55 suffer from erectile dysfunction also seems to argue that the problem goes hand in hand with other symptoms of aging, like hardening of the arteries.

Lately, many researchers have found that impotence occurs if the arteries supplying the penis are clogged. In one study, patients suffering from one or another risk factors for poor blood flow diabetes, smoking, high cholesterol and high blood pressure were more likely to be impotent (The Lancet, January 26, 1985). In fact, a history of smoking (even among those who'd quit) has been shown to be a significant factor in impotence; in one study of impotent patients, twice the percentage of smokers had abnormally low penile blood pressure compared to those who'd never smoked (Urol, June 1986).

The idea is that injecting a prostaglandin, which is a vasodilator, will help in the intermediate term, with the hope that arterial function will be improved.

The biggest problem with the drug is that you must give yourself a shot straight into the penis. In studies, nearly a third of patients report "mild to moderate" penile pain at least once, and 3 per cent discontinued treatment because of the pain.

Other problems, occurring between 1 and 1.5 per cent of patients, include: rash, swelling and fibrosis (scar tissue) of the penis. Less than 1 per cent of patients suffer from hemorrhage, inflammation, itching and swelling of the injection site, bleeding from the urethra, penile numbness, yeast infection, tight foreskin, painful erection and abnormal ejaculation.

With the same frequency, the drug can also cause testicular pain and swelling, upset (frequency and urgency) in urination, low or high blood pressure, vascular disorders, dizziness, and pain of the buttock, leg, genitals or abdomen. In doses higher than 20 micrograms, studies found the drug could cause dangerous lowering in blood pressure and increases in heart rate. Overdoses can cause depression, diarrhea and rapid breathing.

One of the most dangerous side effects is priapism (prolonged erection),which must be treated within six hours by inserting a needle into the spongy tissue of the penis and withdrawing up to 50 ml of blood.

To guard against this, Upjohn recommends that patients be started off at the doctor's office on a low dose (5 micrograms), which should be increased incrementally by 5 mcg until you reach the correct dose. Report any erection of more than four hours to your doctor.

Besides drugs, there are other ways to deal with erectile dysfunction. Besides poor blood supply, many studies have linked impotence with allergy (and your IBS may be a clue that this could be a source of your complaint). Next month, Harald Gaier will look at ways to overcome impotence through diet, herbs and homeopathy, so please keep reading.